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Published on: August 24, 2019
Case finding for chronic obstructive pulmonary disease in primary care: a pilot randomised controlled trial
Shamil Haroon1, Peymane Adab, Carl Griffin
1Public Health, Epidemiology and Biostatistics, University of Birmingham, UK.
Summary
Opportunistic case finding for chronic obstructive pulmonary disease (COPD) in primary care appears more cost-effective than targeted postal questionnaires. Further trials are needed to confirm these findings for undiagnosed COPD.
Area of Science:
- Pulmonary Medicine
- Primary Care Research
- Health Economics
Background:
- Chronic obstructive pulmonary disease (COPD) significantly contributes to morbidity and mortality, with a substantial disease burden often remaining undiagnosed.
- Effective strategies for identifying undiagnosed COPD in primary care are crucial for improving patient outcomes.
Purpose of the Study:
- To compare the diagnostic yield and cost-effectiveness of two distinct COPD case-finding strategies within a primary care setting.
- To evaluate the efficiency of targeted versus opportunistic approaches for detecting undiagnosed COPD.
Main Methods:
- A pilot randomized controlled trial involving 1634 ever-smokers aged 35-79 without prior COPD or asthma diagnoses was conducted in UK general practices.
- Participants were randomized to either a 'targeted' arm (postal questionnaires) or an 'opportunistic' arm (questionnaires during routine GP appointments).
- COPD diagnosis was based on spirometry results (FEV1/FVC < 0.7 and FEV1 < 80% predicted).
Main Results:
- The 'targeted' arm achieved a COPD diagnosis rate of 1.2%, while the 'opportunistic' arm diagnosed 0.7%.
- The cost per case detected was substantially lower in the 'opportunistic' arm (£242.20) compared to the 'targeted' arm (£424.56).
- The opportunistic approach, when optimized, showed a potential yield of 1.95%.
Conclusions:
- Opportunistic case finding in primary care may offer greater cost-effectiveness for detecting COPD compared to solely using targeted postal questionnaires.
- A larger, adequately powered randomized controlled trial is recommended to definitively validate these findings and inform clinical practice guidelines.
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